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Pinning Down Miliband

Labour have been fortunate when it comes to health policy in this Parliament – and if you want to know why, just look to this week’s reshuffle. The man who started this Parliament as Health Secretary was replaced as Leader of the House of Commons, and is now standing down as an MP at the next election. This isn’t entirely attributable to the Health and Social Care Act of 2012, but that legislation does have a lot to do with it. Andrew Lansley introduced a set of policies that are liked even less than they are understood.

Yet, even against that backdrop, Miliband and his party have struggled to shine. They are, it’s true, a good 12 points ahead of the Tories on the question of which party has the best policies for the NHS – but that’s par for this particular course. When it comes to discerning what those policies actually are, and whether they would work, the answers are almost as confusing as Lansley’s Bill. I mean, this is the party that consistently rails against the Coalition’s reorganisation of the health service, but still doesn’t want to (re-)reorganise it into something different. That’s a tricky line to hold.

And this despite the fact that one of Labour’s best frontbenchers occupies the health seat. I know this may not be a popular opinion among ConHome readers, or even outside of them, but it’s the one I hold: Andy Burnham is more alert to the necessities of Britain’s fiscal position than most of his colleagues are. Even before the last election, he was criticising David Cameron’s eagerness for ever-increasing health spending. Since then, he’s been his party’s main advocate for merging the health and social care systems; and on the grounds that it wouldn’t just improve standards but also save cash. I’m not persuaded by how he’d go about this – there’s too much emphasis on local authorities, not enough on individuals – but I agree that a merger, of some sorts, is needed.

The question is: does Miliband agree? And the answer, at least on the surface, is: yes. Integrating health and social care, as they put it, is official Labour policy. The passages devoted to it in Miliband’s recent speech on the NHS – “a simple grab rail” – are among the most convincing he’s ever delivered.

But Miliband seems to disagree with Burnham on how that integration should occur. Earlier this year, the Independent reported that both he and Ed Balls had vetoed their colleague’s plan to create one big budget for councils to then spend. And their reason for doing that? According to the paper, “both men believe that the policy is misguided and would allow the Tories to accuse Labour of imposing another top-down reorganisation in England.” And so it’s that tricky line I mentioned: they want to shake-up the NHS but not in any way that could be called a “reorganisation”. Indeed, the Commission that they set up to investigate the problem was explicitly told, “no further structural change”.

The report that came out of that Commission mostly stayed within its bounds, and didn’t wander down the Burnham route. It basically recommends greater partnership between existing organisations and an expanded role for the Health and Wellbeing Boards that the Coalition birthed in 2012. It also calls for an extra £10 billion for “community care” in the next Parliament; to be taken from… well, that’s to be decided by “an independently-conducted National Conversation backed by all major political parties”. If I were them, I’d have gone for the easy alliteration of National Natter.

As for whether Labour will commit to this natter, we don’t yet know. The Commission’s report has been submitted to the party, which, so far as I can tell, hasn’t yet decided either way. One assumes that they’ll have to before the next election.

For his part, Miliband is filling the time with attacks on Cameron and with basic retail offers. The one that he’s emphasised this year is a “guarantee” that patients will see a GP within 48 hours. It reminds me of similar guarantees made in the last Labour manifesto. In fact, the word “guarantee” appeared in that document over 50 times. A “legally binding” guarantee for cancer test results within one week; for private care if you have to wait over 18 weeks; for a job if you’ve been out of work for two years… and all these guarantees suffered from the problems identified in an insightful Economist article at the time. Specifically, they could lead to an “orgy of litigation” should people not get what they were promised.

Perhaps someone should have pointed this out to the author of Labour’s manifesto. That was some guy called Edward Samuel Miliband.

And how will Miliband pay for his policies now that he’s Labour leader? For the 48-hour guarantee, he talked floppily of reducing spending on consultants and on compliance with EU competition laws. But, beyond that, some in Labour have mooted the possibility of increasing National Insurance rates specifically for funding the health service. An NHS tax, if you will. Something like this has been tried before, when Gordon Brown raised NI rates by 1 per cent in 2002, and it’s not necessarily unpopular with the public. But it does raise some questions for the Labour leader. How would he justify a blanket increase in taxes during this, as he puts it, “cost of living crisis”? What makes this better than, say, charging people to see GPs, which he has dismissed as “Thatcherism”? And so on. Perhaps the Labour leadership will avoid having to answer these inquiries. Balls is said to be opposed to the idea of a tax hike.

Which leaves us with that same question: how will Miliband pay for his policies? With the NHS facing a £30 billion hole in its finances, and with integration expected to cost further £billions even if it delivers savings in the long-run, it’s no moot point. No doubt Labour will point to Ed Balls’ vaunted “zero-based” review of spending, and claim that they’ll prioritise our money correctly. But, as I’ve pointed out before, that doesn’t really mean anything. In the end, it all returns to the first post I wrote in this Pinning Down Miliband series, on Labour’s fiscal plans. They’re asking us to trust them – but why should we?

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